Academic literature on the topic 'United States. Office of Personnel Management. Office of Inspector General'

Health care organizations must continuously improve their productivity to sustain long-term growth and profitability. Sustainable productivity performance is mostly assumed to be a natural outcome of successful health care management. Data envelopment analysis (DEA) is a popular mathematical programming method for comparing the inputs and outputs of a set of homogenous decision making units (DMUs) by evaluating their relative efficiency. The Malmquist productivity index (MPI) is widely used for productivity analysis by relying on constructing a best practice frontier and calculating the relative performance of a DMU for different time periods. The conventional DEA requires accurate and crisp data to calculate the MPI. However, the real-world data are often imprecise and vague. In this study, the authors propose a novel productivity measurement approach in fuzzy environments with MPI. An application of the proposed approach in health care is presented to demonstrate the simplicity and efficacy of the procedures and algorithms in a hospital efficiency study conducted for a State Office of Inspector General in the United States.

The prevalence, costs, and disability associated with chronic pain continue to escalate. So too, the numerous modalities of treatments applied in managing these patients continue to increase as well. In the period from 2000 to 2011 interventional techniques increased 228%. In addition, analysis of utilization trends and expenditures for spinal interventional techniques alone from 2000 to 2008 illustrated an increase in Medicare fee-for-service expenditures of 240% in terms of dollars spent in the United States. The Office of Inspector General (OIG) of the Department of Health and Human Services showed an increase in facet joint and transforaminal epidural injections, with a significant proportion of these services did not meet the medical necessity criteria. The increasing utilization of interventional techniques is also associated with significant variations among specialty groups and regional variations among states. Overall procedures have increased by 173%, with rate of 130% per 100,000 Medicare beneficiaries for epidural injections; 383%, with a rate of 308% for facet joint interventions; and overall 410%, or a rate of 331% for sacroiliac joint interventions. Certain high volume interventions such as lumbar transforaminal epidural injections and lumbar facet joint neurolysis have actually increased a staggering 806% and 662%. Coverage policies across ambulatory settings and by multiple payers are highly variable. Apart from variability in the development of coverage policies, payments also substantially vary by site of service. In general, amongst the various ambulatory settings the highest payments are made to hospital outpatient departments (HOPDs) the lowest to in-office procedures, and payment to ambulatory surgery centers (ASCs) falling somewhere in the middle. This manuscript describes the many differences that exist between the various settings, and includes suggestions for accountable interventional pain management with coverage for techniques with evidence, addressing excessive use of specific techniques, and equalizing payments across multiple ambulatory settings. Key words: Accountable interventional pain management, Medicare, Medicare Evidence Development & Coverage Advisory Committee, epidural injections, facet joint interventions, sacroiliac joint injections, payment policies

256 Background: In 2000, Office of Inspector General (OIG) provided guidance for physician practices in the adoption of corporate compliance program (CCP). The notice provided a basic outline that would allow organizations to detect, prevent and possibly report potential fraud and abuse as it relates to federal health care payers. Insurance payers, e.g., United, Healthcare, and Humana, are also requiring organizations to institute CCP for reimbursement. As health care reform evolves there is will be a greater need for an alliance between providers and payers as each are increasingly held accountable for their actions related to ethical behavior in documentation, billing and coding, HIPAA, improper inducements, kickbacks, financial conflicts of interest, in addition to other areas. Methods: The Illinois CancerCare (ILCC) is one of the largest private oncology practice in Midwest. We implemented the components outlined by OIG by completing the following tasks: identifying and empowering a compliance officer; identifying high-risk areas; developing policies and standards for major processes that might lead to fraud, waste, or abuse; developing a training program for all physicians, NPs, and employees; creating and implementing an auditing and monitoring program; developing investigation and remediation standards; and establishing committees for oversight. Results: The entire process took 18 months to be fully functional. We have developed a plan that is completely complaint and meets all the criteria as required and our personnel have been trained. Conclusions: In future most large practices in the United States will likely be required to have a CCP. It is complicated and includes multistep processes. In the end, implementing a CCP allows organizations to show their desire to be a quality organization with internal monitors to ensure they are participating in federal health care programs using ethical standards.

Background: Reports from the United States Government Accountability Office (GAO), the Institute of Medicine (IOM), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) continue to express significant concern with the overall fiscal sustainability of Medicare and the exponential increase in costs for chronic pain management. Study Design: The study is an analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 2000 to 2011. Objective: To evaluate the use of all interventional techniques in chronic pain management. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master Data from 2000 to 2011. Results: Interventional techniques for chronic pain have increased dramatically from 2000 to 2011. Overall, the increase of interventional pain management (IPM) procedures from 2000 to 2011 went up 228%, with 177% per 100,000 Medicare beneficiaries. The increases were highest for facet joint interventions and sacroiliac joint blocks with a total increase of 386% and 310% per 100,000 Medicare beneficiaries, followed by 168% and 127% for epidural and adhesiolysis procedures, 150% and 111% for other types of nerve blocks and finally, 28% and 8% increases for percutaneous disc procedures. The geometric average of annual increases was 9.7% overall with 13.7% for facet joint interventions and sacroiliac joint blocks and 7.7% for epidural and adhesiolysis procedures. Limitations: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, as well as potential documentation, coding, and billing errors. Conclusion: Interventional techniques increased significantly in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 177% in the utilization of IPM services per 100,000 Medicare beneficiaries, with an annual geometric average increase of 9.7%. The study also showed an exponential increase in facet joint interventions and sacroiliac joint blocks. Key words: Interventional techniques, interventional pain management, facet joint injections, epidural steroid injections, sacroiliac joint injections, chronic pain, chronic spinal pain

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9–2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine–Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

Background: Recent reports of the United States Government Accountability Office (GAO), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) expressed significant concern with overall fiscal sustainability of Medicare and exponential increase in costs for interventional pain management techniques. Interventional pain management (IPM) is an evolving specialty amenable to multiple influences. Evaluation and isolation of appropriate factors for increasing growth patterns have not been performed. Study Design: Analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 1997 to 2006. Objective: To evaluate the use of all interventional techniques. Methods: The standard 5% national sample of the CMS carrier claim record data for 1997, 2002, and 2006 was utilized. This data set provides information on Medicare enrollees in the feefor-service Medicare program. Current procedural technology (CPT) codes for 1997, 2002, and 2006 were used to identify the number of procedures performed each year, and trends in expenditures. Results: Interventional techniques increased significantly in Medicare beneficiaries from 1997 to 2006. Overall, there was an increase of 137% in patients utilizing IPM services with an increase of 197% in IPM services, per 100,000 Medicare beneficiaries. The majority of the increases were attributed to exponential growth in the performance of facet joint interventions. There was a 13.9-fold difference in the increase between the state with the lowest rate and the state with the highest rate in utilization patterns of interventional techniques (California 37% vs. Connecticut 514%), with an 11.6-fold difference between Florida and California (431% vs. 37% increase). In 2006, Florida showed a 12.7-fold difference compared to Hawaii with the lowest utilization rate. Hospital outpatient department (HOPD) expenses constituted the highest increase with fewer patients treated either in an ambulatory surgery center (ASC) or in-office setting. Overall HOPD payments constituted 5% of total 2006 Medicare payments, in contrast to 57% of total IPM payments, an 11.4-fold difference. Limitations: The limitations of this study include a lack of inclusion of Medicare participants in Medicare Advantage plans and potential documentation, coding, and billing errors. Conclusion: This study shows an overall increase of IPM services of 197% compared to an increase of 137% in patients utilizing IPM services from 1997 to 2006. Key words: Interventional techniques, interventional pain management, facet joint injections, epidural steroid injections, sacroiliac joint injections, chronic pain, chronic spinal pain, ambulatory surgery center (ASC), hospital outpatient department (HOPD)

Background: Both the Office of Inspector General (OIG) and reports from studies of the utilization of facet joint interventions have expressed that explosive increases in facet joint interventions provided to spinal pain patients are a major concern. Study Design: The study is designed to assess the growth of facet joint interventions in managing spinal chronic pain in Medicare beneficiaries from 2000 to 2011. Objective: To assess the use of facet joint interventions in chronic pain management. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) physician supplier procedure summary master data from 2000 to 2011. Results: The utilization of all types of facet joint interventions increased enormously from 2000 to 2011, with an overall increase of 308% per 100,000 Medicare beneficiaries and a 13.6% average annual increase. In addition, the highest increases were seen for cervical/ thoracic radiofrequency neurotomy with 836%, followed by an increase of 662% for lumbar/ sacral radiofrequency neurotomy, a 359% increase in cervical/thoracic facet joint injections, and 228% increase in lumbosacral facet joint injections. In reference to the number of procedures performed, however, the highest numbers were in the lumbosacral region with 990,449 total procedures of lumbar facet joint blocks and 406,378 lumbosacral radiofreqency neurotomies in 2011. Cervical and thoracic facet joint nerve blocks were 317,220, whereas cervical and thoracic radiofrequency neurotomies were 97,526 in 2011. The data also showed that there were enormous increases in the proportion of procedures performed by the specialty of physical medicine and rehabilitation, with an increase of 781% and an annual increase of 21.9% excluding physicians of physical medicine and rehabilitation enrolled as interventional pain management or pain management. Even though the numbers were very low for nurse anesthetists, nurse practitioners, and physician assistants, the increases were from 143 in 2000 to 21,263 in 2011, providing an annual increase of 55.2%, an overall increase of 12,460%. Limitations: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, as well as potential documentation, coding, and billing errors. Furthermore, the data provided for state utilizations is based on claims data for that state which also may include patients from contiguous or other states receiving services in those states. Conclusions: The explosive increase in the number of lumbar facet joint interventions performed began to wane in 2008. From 2008 to 2010, the utilization of facet joint interventions declined by 6%. Key Words: Chronic spinal pain, interventional pain management, interventional techniques, facet joint injections, medial branch blocks, radiofrequency neurotomy

The article is dedicated to Heorhiy H. Shevel, Minister for Foreign Affairs of Soviet Ukraine from August of 1970 to November of 1980.The authors presented sincere recollections about this well known person, under whose leadership they began their diplomatic service that lasted for several decades. The decision to share those memories with readers of Diplomatic Ukraine was prompted by the fact that on May 9 this year was Mr. Shevel`s 100 anniversary. Unfortunately, neither the researchers of the history of Ukrainian diplomacy, nor those in charge of the Ministry of Foreign Affairs and the Diplomatic Academy paid the necessary tribute to this event. The authors of the article focus on the fact that with no previous experience in foreign policy matters Mr. Shevel managed in the conditions of a totalitarian Soviet system to realize important ideas in the interests of the Ukrainian diplomatic service and its development. From the very start of his duties as Minister of Foreign Affairs he undertook many practical steps to promote and improve the professional skills of his subordinates, to ensure their perfect command of foreign languages and to provide the Ministry`s staff and Ukraine`s permanent missions at the United Nations in New York, UNESCO in Paris and at other international organizations with a skilled personnel. Moreover, despite essential dependence on the policy of the USSR Ministry of Foreign Affairs, Mr. Shevel also succeeded in ensuring more visible results of participation of the Ukrainian SSR in the activities of the United Nations Economic Commission for Europe and in the International Labour Organization. During his term as Minister for Foreign Affairs, representatives of the Ukrainian SSR were elected 37 times to the governing bodies of various international organizations, their sessions and conferences. As an evidence of substantial resurgence of Ukrainian diplomacy of the said period is the fact that the Ukrainian SSR also signed and ratified 64 multilateral international documents. Minister Shevel also paid particular attention to establishing Ukraine`s image abroad as one of the original members of the United Nations, by promoting its achievements in scientific, cultural and humanitarian fields, as well as to strengthening ties with Ukrainian communities in various foreign countries. This very important component of its work the Ministry of Foreign Affairs accomplished in close cooperation with two public organizations – the Society for ties with Ukrainians abroad (Society Ukraina) and the Ukrainian Society for friendship and cultural relations with foreign countries. Minister H. Shevel was also the initiator of the construction in Kyiv of several buildings to locate Consulates–General of Eastern-European states. Nowadays, these buildings are used by diplomatic missions of respective foreign states accredited in independent Ukraine. The authors of the reviewed article are confident that despite various fabricated and often unfounded conclusions about the Ukrainian diplomacy of the Soviet period the irrefutable fact is that during Minister Shevel`s years it acquired and strengthened the necessary practical experience and professional diplomatic skills. Therefore, they support as indisputable the conclusion made several years ago by one of the researchers of the history of National diplomacy that “it would be incorrect to consider the 1970s of the past century as such that passed off in vain for the Ukrainian foreign-policy office”.30 years have passed since the untimely death of Heorhiy H. Shevel on July 17, 1989. Being a man of his times and performing highly responsible duties of the Minister of Foreign Affairs, in actually limited framework, he was at the same time a peculiar and extraordinary personality. And as such a figure he will always remain in the memory of all who knew him well and had the opportunity to work under his management. Because memory, emphasize the authors of the noted article, means first and foremost the ability not to forget the past. And this, they remark, is what the present generation of Ukrainian diplomats must keep in view and never forget. Keywords: Ministry of Foreign Affairs, Ukrainian diplomacy, foreign policy, international organizations, diplomatic service, memory.

It is a great pleasure to introduce the second volume second issue of our journal into the global community yearning for high-quality, impactful papers. IPJAF continues to seek and provide readers throughout the world with technology supported peer-reviewed scholarly articles on a broad range of established and emergent areas of accounting, finance, business, economics, and social sciences. I am resolute to maintain the high-quality standard of research and publication which is anchored on the exemplary service and dedication of our editorial board, editorial review and the editorial office. This volume 2, issue 2 comprises five manuscripts dealing with financial accounting, taxation, and auditing. The first article entitled “Examining the independent audit committee, managerial ownership, independent board member and audit quality in listed banks” by Dr. Hisar Pangaribuana (Adventist University of Indonesia, Bandung, Indonesia), Dr. Jenny Sihombinga (Adventist University of Indonesia, Bandung, Indonesia), and Dr. Oluwatoyin Muse Johnson Popoola (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia) examines the effects of the independent audit committee on the relationship between managerial ownership and independent board member on audit quality in the Indonesian listed banks. The unit of analysis is companies carrying on the banking business and listed on the Indonesian stock exchange (IDX) between the period of 2010 to 2015. This study is explanatory (i.e., causal predictive), and uses the second generation structural equation modelling statistical analysis tools, PLS-SEM and PROCESS Partial Least Square for hypotheses testing. The results show that the independent board member has a significant impact on the independent audit committee and the audit quality. The study reveals that managerial ownership does not influence audit quality. The adoption of the independent audit committee with a long tenure of years can be potentially risky and less creative. As a result, their oversight functions may be in jeopardy, impaired or reduced performances. The research findings reveal no significant indirect effects of the independent audit committee on the relationship between managerial ownership, independent board member and audit quality in the banks listed in IDX. Independent board members need to renew the appointment of the independent audit committee members to improve the quality of the oversight functions undertaken by the audit committee, and hence, enhance audit quality. The authors suggest further research on the ideal level of managerial ownership and number of an independent board member to produce a good audit quality in the Indonesian listed banks. The second article titled “Salaried taxpayers’ internal states and assessment performance under self-assessment system: a quasi-experimental evaluation” by Dr. Noraza Mat Udin (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia) takes a look at the first reform that impacts taxpayers, that is, the implementation of self-assessment system (SAS) to replace the old assessment system in 2004. The perception is that SAS had entirely changed the taxpayers’ responsibilities from being assessed by the tax authority to a person who is responsible for assessing own income tax liability. Her study explores the public fora debates on whether taxpayers can perform their responsibilities that were previously handled by trained tax personnel in Malaysia. Her paper reports the findings of a quasi-experimental evaluation of salaried individual taxpayers’ in the early stage of SAS implementation. She argues that a lot needs to be done, notwithstanding SAS had been implemented for more than a decade, the problem of taxpayer performance is continuing due to the dynamic nature of taxation in reality. The data were collected using a quasi-experimental method known as posttest-only no-treatment control group design. The sample comprised post-graduate students, who were actual taxpayers. Among the elements of the taxpayer’s internal states considered in this study, tax knowledge was found to have a significant relationship with assessment performance. Further analysis was conducted which showed that the majority of tax knowledge dimensions had a significant relationship with taxpayer assessment performance. The findings of this study have contributed to the body of knowledge because there is a general dearth of published research, particularly in Malaysia that investigates taxpayer assessment performance especially using an experimental approach. The third article with a caption, “Working capital management and firm performance: lessons learnt during and after the financial crisis of 2007-2008 in Nigeria” by Mr. Sunday Simon (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Dr. Norfaiezah Sawandi (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), and Prof. Dr. Mohamad Ali Abdul-Hamid (Department of Accounting, College of Business Administration, University of Sharjah, United Arab Emirate) examines the relationship between working capital management (WCM) and firm performance during and after the financial crisis of 2007-2008 in Nigeria. The authors argue that the financial crisis could be attributable to the deterioration and ultimate failure of WCM performance that affected many Nigerian firms. During the crisis, lending conditions were deeply affected, and financing operations became challenging for firms. Although research findings on the causes and effects of the crisis on the economy are known, what remains unknown is whether the financial crisis had a significant impact on WCM performance. The differences between the two periods, the crisis period and then after the crisis period, is operationalised through two analyses. The findings indicate that WCM variables have more explanatory power (R2) in the period after the crisis than during the crisis. Also, the results of the Cramer Z-statistic, which examined between sample comparisons of the R2, revealed that the Z-scores are significant, implying that a significant difference existed between the two periods. It suffices to say that WCM was affected during the financial crisis and led to low profitability, whereas, during the after-crisis period, WCM associates with higher profitability. These findings have implications for managers and policymakers because access to financing has become a global problem and adequate WCM management increases a company’s resilience to financial and external shocks. The fourth article entitled “The Influence of Technology Readiness on Information Technology Competencies and Civil Conflict Environment” by Prof. Dr. Kamil Md. Idris (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Associate Prof. Dr. Akilah Abdullah (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Haetham H. Kasem Alkhaffaf (OYA Graduate School of Business, College of Business, Universiti Utara Malaysia), and Al-Hasan Al-Aidaros (Islamic Business School, Universiti Utara Malaysia, Malaysia). Their study confirms prior findings that the Technology Readiness scale can capture the association among technology readiness and technology usage behaviours. The study also expands earlier research by investigating the impact of technology readiness on individual competency among accountants to using IT in a workplace under the intensity of civil conflict in Iraqi environment. The result shows that there is a positive significant relationship between technology readiness and the IT competencies of Iraqi accountants. It implies that the technology readiness regarding willingness, enthusiasm, and motivation of accountants using IT has an impact on their IT competencies. In other words, the higher the readiness of the accountants in making use of technology, the higher their competence in the use of IT. This study contributes to the body of knowledge in terms of theory, method and practice in Iraq especially and developing countries in general. The fifth article titled “Mediating effect of Quality-differentiated Auditor on the relationship between Managerial ownership and Monitoring mechanisms” and authored by Dr. Rachael Oluyemisi Arowolo (Chrisland University, Nigeria), Prof. Dr. Ayoib Che-Ahmad (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia), Dr. Oluwatoyin Muse Johnson Popoola (Tunku Puteri Intan Safinaz School of Accountancy, College of Business, Universiti Utara Malaysia) and Dr. Hisar Pangaribuana (Adventist University of Indonesia, Bandung, Indonesia) examines the relationship between Managerial Ownership (MO) and MMs with quality-differentiated auditors (QDA) as the channel for the relationship. Over the past decade, most studies in corporate governance and audit market emphasised the importance of monitoring mechanisms (MM), especially after the global economic meltdown resulting from the Enron saga. The literature on MM continues growing as many countries especially the Sub-Saharan Africa are still struggling to come out of the effect of the economic meltdown and businesses continues to fail or merge. The study used data from non-financial listed companies in Nigeria providing empirical supports that MO significantly associates with MMs in the right direction. Likewise, QDA also influences the MMs in the right direction suggesting that QDA is necessarily required to enhance adequate MMs. The findings of this study provide support for the association of MO and MMs with the intervention of QDA for solutions to agency problems. Companies should, therefore, motivate the management to own shares within the reasonable range that aligns the interest of the management with that of the shareholders. This paper adds to knowledge especially in Nigeria and Sub-Saharan Africa by examining a mediating effect to depict the relationship between MO and MM, which are not evident in prior studies It is my conviction that in the coming year, the vision of IPJAF to publish high-quality manuscripts in the established and emergent areas of accounting and finance from academic and professional researchers will be sustained and appreciated. As you read throughout this volume 2, issue 2 of IPJAF, I would like to remind you that the success of our journal depends on you, your friends and colleagues as stakeholder through the submission of high-quality articles for review and publication. Once again, I acknowledge with gratitude your continued support as we strive to make IPJAF the most authoritative journal on accounting and finance for the community of academic, professional, industry, society and government. Oluwatoyin Muse Johnson Popoola, PhD Editor-in-Chief popoola@omjpalpha.com

ABSTRACT The high incidence of healthcare fraud in the United States resulted in the creation of multiple outlets to report fraud, such as the Medicare Hotline, the Office of the Inspector General, and the filing of False Claim Act lawsuits associated with whistleblower rewards. Despite the high incidence, examinations of whistleblowing factors in this industry, such as whistleblowers’ professional roles and fraud types, are scarce, and the interaction effects of these factors are unknown. In this study, participants from two different professional roles disclose their likelihood of reporting Medicare fraud through the aforementioned three reporting outlets conditional on two different billing fraud types. The results indicate that although workers in both professional roles show similar likelihoods to report fraud regardless of the reporting outlet, fraud type and its interaction with the professional role influence some but not all the reporting likelihoods.